Provider Demographics
NPI:1548022429
Name:WINTON, AMBER KATHLEEN (PA-C)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:KATHLEEN
Last Name:WINTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 HARDING PL APT 340
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3069
Mailing Address - Country:US
Mailing Address - Phone:239-850-4308
Mailing Address - Fax:
Practice Address - Street 1:141 PROVIDENCE RD STE 112
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1217
Practice Address - Country:US
Practice Address - Phone:980-390-5990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-14013363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant